1093916231 NPI number — DR. JOHN PANZICA D.D.S.

Table of content: DR. JOHN PANZICA D.D.S. (NPI 1093916231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093916231 NPI number — DR. JOHN PANZICA D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANZICA
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093916231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 2610
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60602-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-853-3431
Provider Business Mailing Address Fax Number:
312-853-3432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1535 LAKE COOK RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-498-9767
Provider Business Practice Location Address Fax Number:
847-498-9045
Provider Enumeration Date:
05/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  019.017250 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 019.017250 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)